• Maggie Evans, Debbie Sharp, and Ali Shaw.
• School of Social and Community Medicine, University of Bristol, Bristol, UK. m.a.evans@bristol.ac.uk
• Patient Educ Couns. 2012 Dec 1;89(3):374-80.

ObjectiveTo improve our understanding of patient participation in health care consultations and decision-making by exploring a consultation that lies at the interface between mainstream care and complementary therapies.MethodsThirty-four holistic consultations were observed at centres offering complementary therapies for cancer, followed by interviews with patients and focus groups with professionals.ResultsA model of decision-making about complementary therapy use emerged from the data: 'Advice: Assessor led decision', 'Confirmation: Joint decision', 'Access: Patient-led decision' and 'Informed: Patient-led decision'. Decision-making style was contingent on identifiable communication strategies in the preceding information-sharing and discussion phases of the consultation.ConclusionThis study confirms the importance of gauging patients' preferences for level of participation in decision-making. Models of consultations are generally based on the assumption that a greater degree of patient participation is a good thing that access to information and decision-making power is sought by all patients. Data from this study suggest that, in this context at least, this is not necessarily the case. The study also stresses the dynamic nature of the consultation, in which roles are fluid rather than fixed.Practice ImplicationsInsight were gained into professionals' communication strategies and patients' role preferences in decision-making, which may be applicable more widely.Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

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